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Neurology > Multiple Sclerosis > Flashcards

Multiple Sclerosis Flashcards

1
Q

What type of hypersensitivity reaction is Multiple Sclerosis?

A

Type IV hypersensitivity reaction

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2
Q

What is this describing?

Inflammation plaques of demyelination in the CNS occurring at multiple sites with >30 days between attacks.

A

Multiple Sclerosis

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3
Q

What percentage of Multiple Sclerosis patients develop progressive disability, when is the mean age of onset, and which gender is affected more?

A
  1. > 80%
  2. 28-31
  3. Females 3x more likely than males
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4
Q

What are the causes of Multiple Sclerosis?

A
  1. Genetic

2. Environmental - smoking, vitamin D, EBV

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5
Q

What are the causes of peripheral demyelination?

A
  1. Myelin attacked - MS, inflammatory demyelinating diseases

2. Myelin not produced - B12 deficiency, central pontine myelinolysis

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6
Q

What are the causes of central demyelination?

A

Guillain-Barre and Charcot-Marie-Tooth

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7
Q

What is this a presentation of?
Unilateral optic neuritis (loss of red colour vision, pain, vision loss, blurred vision), bladder and pyramidal symptoms, worsen with heat.

A

Multiple Sclerosis

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8
Q

What are the sensory features of multiple sclerosis?

A

Numbness, paraesthesia, reduced vibration sense, trigeminal neuralgia.

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9
Q

What are the motor features of multiple sclerosis?

A

Weakness, dysarthria (interferes with eating, talking, swallowing)

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10
Q

What are the sexual/GU features of multiple sclerosis?

A

Erectile dysfunction, anorgasmia, urine retention or incontinence (detrusor hyper-excitability or sphincter incompetence).

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11
Q

What are the GI features of multiple sclerosis?

A

Movement causes pain and double vision, hemianopia, optic neuritis, pupil defects (RAPD).

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12
Q

What are the cerebellar features of multiple sclerosis?

A

Trunk and limb ataxia, intention tremor, monotonous speech, falls.

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13
Q

What are the cognitive features of multiple sclerosis?

A

Amnesia, low mood, reduced executive function.

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14
Q

What is Lhermitte’s sign and what causes it?

A
  1. Neck flexion causes electric shock in trunk/limbs.

2. Multiple sclerosis, B12 deficiency, cord tumours.

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15
Q

What is Uhtoff’s phenomenon and what causes it?

A
  1. Symptoms worse with heat

2. Multiple sclerosis

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16
Q

What is found on an MRI in multiple sclerosis?

A

Scarred areas of demyelinated neurones seen as plaques.

17
Q

What is found on LP in multiple sclerosis?

A

Oligoclonal bands of IgG not present in serum.

18
Q

What is found on evoked potentials in multiple sclerosis?

A

Increased latency = slower action potential = optic neuritis

19
Q

What is the criteria used for the diagnosis of multiple sclerosis?

A

McDonald criteria:

  1. Dissemination of disease activity in time (>1 month)
  2. Dissemination of disease activity in space (>1 site)
20
Q

What are the different types of progression of multiple sclerosis?

A
  1. Relapsing-remitting (85%)
  2. Secondary progression (after relapsing-remitting)
  3. Primary progressive (10%)
21
Q

What are the three principles of management for multiple sclerosis?

A
  1. Treatment of acute attacks
  2. Prevention of future attack by reducing triggers
  3. Disease-modifying drugs
22
Q

What are the lifestyle changes suggested for multiple sclerosis?

A

Regular exercise, stopping smoking, sleep hygiene, avoid stress/caffeine/vitamin waters.

23
Q

What is the effect of DMARDs on relapses of multiple sclerosis?

A

Increases time between relapses but does not reduce them.

24
Q

When do you start a multiple sclerosis patient on DMARDs?

A

Straight away or if they have >2 remissions in one year

25
Q

What are the DMARDs available for multiple sclerosis?

A
  1. Dimethyl fumarate (mild/moderate relapsing-remitting MS)

2. Monoclonal Abs against T cells (alemtuzumab) and receptors allowing immune cells to cross BBB (natalizumab)

26
Q

What are the options for treating progressive multiple sclerosis?

A

Fewer options than relapsing-remitting:

  1. Manage symptoms
  2. Physical therapy
  3. CBT
  4. Vitamin D
27
Q

How can acute multiple sclerosis relapses be shortened?

A

Methylprednisolone IV/PO for 3-5 days

28
Q

What management is used in multiple sclerosis for these symptoms?

  1. Spasticity
  2. Pain and sensory symptoms
  3. Tremor
  4. Urgency/frequency
  5. Fatigue
A
  1. Baclofen/gabapentin
  2. Low dose anti-convulsants (gabapentin)
  3. Botulinum toxin A injection, propranolol
  4. If post-micturition >100ml then self-catheterisation, if <100ml try tolterodine.
  5. Amantadine, CBT, exercise
29
Q

What are the complications of multiple sclerosis?

A

UTIs, osteoporosis, depression, visual impairment, erectile dysfunction, impaired mobility, cognitive impairment.

Neurology (51 decks)

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